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研究生:林美賢
研究生(外文):Mei-hsien Lin
論文名稱:急診醫護人員衣著表面微生物分佈之研究
論文名稱(外文):Research of the Microbial Distribution among Emergency Department Healthcare Workers'' Clothing Surface
指導教授:林俊宏林俊宏引用關係
指導教授(外文):Jun-hong Lin
學位類別:碩士
校院名稱:南華大學
系所名稱:自然醫學研究所
學門:醫藥衛生學門
學類:其他醫藥衛生學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:124
中文關鍵詞:菌落分佈衣服表面急診部門
外文關鍵詞:clothing surfacecolony forming units (CFU)Department of Emergency
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  研究背景:近年發現織品可以被檢驗出微生物,甚至可能造成傳染媒介的來源。但目前較少文獻探討醫院織品表面微生物及其影響。本研究以探討急診醫護人員不同衣著表面微生物暴露及分佈之情況。
 
  研究方法:實驗組共分為四組,分別為白長袍及白短袍各5件,急診藍色短上衣及急診護士服短上衣各10件,上班8小時後立即依區域定面積裁剪。將樣品洗出的菌液塗抹在Standard Lysogeny Broth Medium (LB medium),再置入37oC培養箱培養24小時,計算衣服不同部位菌落形成單位,觀察微生物數量。此外,實驗空白組(1)及實驗空白組(2)分別為白長袍、白短袍、急診藍色短上衣及急診護士服短上衣各2件:1件為剛送洗回來,1件吊掛在急診現場8小時,依照實驗組相同步驟進行。數據資料以Microsoft Office Excel 2007、SigmaPlot及SPSS 18.0統計套裝軟體進行分析,資料顯著水準界定為p < 0.05。白長袍與白短袍、藍色上衣與護士服上衣兩組之組內差異以independent t test進行。白長袍、白短袍、藍色上衣與護士服上衣各組間及四種類制服相同部位差異以ANOVA比較。
 
  研究結果:醫師用白長袍菌落分佈最高區域為後面領子周圍33 CFU/cm2,白短袍菌落分佈最高區域為右袖口20 CFU/cm2,菌落分佈最低皆為中間扣子;藍色制服上衣菌落分佈最高區域為右腋下144 CFU/cm2,護士服上衣菌落分佈最高區域為左腋下697 CFU/cm2,菌落分佈最低各為腹部區域及衣服背面最下緣。長袖白袍相比,後面領子 (p = 0.045) 及右袖口 (p = 0.041) 有顯著差異;短袖制服間相比,左腋下 (p = 0.01) 及右腋下 (p = 0.026) 有顯著差異;四種制服相比,聽診器掛置的領子處有顯著差異 (p = 0.002)。
 
  結論:本研究結果顯示接觸配掛物件及皮膚接觸部位菌落量較高。所以建議醫院除加強洗手衛生之外,應該也要加強制服衛生的觀念。建議由醫院提供制服來解決制服數量及送洗時間安排的問題,並律訂物件配掛及消毒方式。
  In recent years, microorganisms can be found on various fabrics, but few studies on the microbes and their impact on the surface of hospital fabrics. This study aimed to explore the healthcare-workers’ clothing surfaces and the number of microbial strains among Department of Emergency. We performed a cross-section study to investigation the department of a teaching hospital in Southern Taiwan. Sampled healthcare workers worked 8-hours, then white coats, blue short-sleeved uniform and nursing short-sleeved uniform were cultured for experiments. For comparison, the colony forming units (CFU) in different parts of clothes were counted after 24-hours cultivation. Among the 5 attendees’ white coat, the most frequent sites of positive culture are collar area of hanging the stethoscope and up to 33 CFU/cm2. Among the 5 residents’ white coat, the most frequent sites of positive culture are right cuffs and up to 20 CFU/cm2. Among the 10 blue short-sleeved uniform, the most frequent sites of positive culture are right axillary area and up to 144 CFU/cm2. Among the 10 nursing short-sleeved uniform, the most frequent sites of positive culture are left axillary area and up to 697 CFU/cm2. This study will understand the clothing surface of microbial distribution and suggest about the healthcare workers clothing hygiene. Expectations of the future fabric cloth material available to use and reference antimicrobial coating.
摘要 I
ABSTRACT III
目次 V
表目次 X
圖目次 XIII
 
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機 2
1.3 研究目的 3
 
第二章 文獻回顧 4
2.1 病原微生物之暴露 4
2.2 微生物存活在醫療織品表面之條件與影響 5
2.2.1 微生物存活在醫療織品表面之條件 6
2.2.2 微生物存活在醫療織品表面之影響 9
2.3 織品微生物之採樣及定量技術 10
2.3.1 織品微生物之採樣技術 11
2.3.2 織品微生物之定量技術 12
2.4 微生物菌種之鑑定方法 14
2.4.1 菌種基因鑑定分型 14
2.4.2 變性梯度膠體電泳 15
2.4.3 選擇性培養基 16
2.4.4 醫檢快篩 17
 
第三章 研究方法 18
3.1 實驗設計 18
3.1.1 實驗流程 21
3.2 實驗材料 22
3.2.1實驗耗材及儀器 22
3.2.2實驗藥品 24
3.2.3採樣及調查方法 26
3.2.4織品微生物定量方法 29
3.2.5計算公式 30
3.2.6 PCR-DGGE 31
3.3 研究倫理 36
3.4 統計方法 37
 
第四章 研究結果 38
4.1 研究基本資料 38
4.1.1急診室各種類型制服採樣人數百分比 38
4.1.2制服材質 39
4.1.3急診各種類型制服各班別採樣人數百分比 39
4.2 白長袍使用習慣及微生物分佈 40
4.2.1白長袍基本資料與使用習慣 40
4.2.2 溫度與濕度 46
4.2.3 實驗空白 46
4.2.4 菌落分佈 47
4.3 白短袍使用習慣及微生物分佈 50
4.3.1白短袍基本資料與使用習慣 50
4.3.2 溫度與濕度 55
4.3.3 實驗空白 56
4.3.4 菌落分佈 57
4.4 藍色制服上衣使用習慣及微生物分佈 60
4.4.1 藍色制服上衣基本資料與使用習慣 60
4.4.2 溫度與濕度 64
4.4.3 實驗空白 65
4.4.4 菌落分佈 66
4.5 護士服上衣使用習慣及微生物分佈 69
4.5.1 護士服上衣基本資料與使用習慣 69
4.5.2 溫度與濕度 73
4.5.3 實驗空白 74
4.5.4 菌落分佈 75
4.6 菌落分佈最高部位比較 78
4.6.1長袖白袍 (白長袍與白短袍) 培養結果比較 78
4.6.2短袖上衣 (藍色制服與護士服) 培養結果比較 82
4.6.3四種類型衣服培養結果比較 85
4.7 DGGE實驗結果 88
 
第五章 討論 92
5.1 溫度與濕度 92
5.2 實驗空白 92
5.3 接觸病患人數之影響 93
5.4 影響菌落分佈因素 94
5.4.1佩掛物件之影響 94
5.4.2與環境接觸之影響 96
5.4.3衣服材質及汗液之影響 96
5.4.4衣物放置習慣 98
5.5 菌落分佈最低部位 99
5.6 PCR-DGGE實驗結果 100
5.7 制服與環境菌落數比較 102
5.8 衣物清洗頻率 103
5.9 穿著制服原因探討 104
 
第六章 結論與建議 106
6.1 結論 106
6.2 研究限制及建議 108
 
參考文獻 111
 
附錄 119
1. 白長袍裁剪標示 119
2. 白短袍裁剪標示 121
3. 藍色制服上衣裁剪標示 123
4. 護士服上衣裁剪標示 124
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